Healthcare Provider Details

I. General information

NPI: 1568753382
Provider Name (Legal Business Name): MARY ROSE PARAWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 E 57TH ST
BROOKLYN NY
11203-3731
US

IV. Provider business mailing address

94 EAST 57TH ST
BROOKLYN NY
11203
US

V. Phone/Fax

Practice location:
  • Phone: 917-721-5135
  • Fax: 718-485-9502
Mailing address:
  • Phone: 917-721-5135
  • Fax: 718-485-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number22386043
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License Number22386043
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number22386043
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number22386043
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number22386043
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number22386043
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number22386043
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number22386043
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number22386043
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: